Provider Demographics
NPI:1952057002
Name:OMNI-GO LLC
Entity Type:Organization
Organization Name:OMNI-GO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:OVAIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUBERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-572-8557
Mailing Address - Street 1:1874 WHITEHAWK CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-6641
Mailing Address - Country:US
Mailing Address - Phone:224-572-8557
Mailing Address - Fax:
Practice Address - Street 1:7867 TARA BLVD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2203
Practice Address - Country:US
Practice Address - Phone:470-632-7727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory